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THE FEDERALIST SYSTEM

The United States has a federalist system: a central government that has certain powers, with the state as the basic unit of political power. The allocation of power between the state and federal government has been a point of contention from the Articles of Confederation to the present day. Historically, the states retained power over domestic matters. The federal government was given power over trade between the states and foreign policy issues. The federal government took greater power over domestic affairs with the Civil War, and this shifting of power increased during the 1930s as a result of the constitutional battles over the authority of the federal government to pass laws designed to end the depression. The civil rights acts passed in the 1960s and 1970s shifted the balance of power between the state and federal governments even further. The 1980s saw the federal government assume more power through mandating entitlement programs (such as Medicare and Medicaid) while reducing the federal support for these programs.

It is the federal government that determines the extent to which medical practice regulations will be uniform in the different states. In most areas of medical practice, the states maintain the central regulatory role. They license physicians, determine the tort rules under which physicians practice, and put additional restrictions on federal laws, such as the food and drug laws. This means that physicians practicing the same specialty in different states have to modify their practice in accordance with their state's laws.

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